1. 성균관대학교 의과대학 2007313075 손의영

2. Chief Complain 이 O 연, F/71 Abnormality of Chest X-ray

3. Present Illness Previously healthy 2011. 02 건강검진상 발견된 RUL 의 solitary pulmonary nodule 평소 이상 증상 없었음 2011.04.03 Lung cancer w/u 위해 입원

4. Other History PMHx. HTN/DM/Tb/hepatitis/Allergy ( - / - / - / - / - ) 약물력 : Local 에서 Both knee 에 OA 진단 받고 Medication 중 수술력 오른쪽 백내장 수술 ( 왼쪽도 받을 예정 ) 2010. 치질 수술 FHx. 넷째 오빠 심장병으로 수술 받으신 것 외에 특이사항 없음 SHx. occupation: 농업, 임업 smoking: no alcohol: no 생강과 마가 섞인 한약재를 가끔 드심

5. Review of system GW / EF ( - / - ) Weight change : 6mo 동안 6kg 증가 (d/t increased appetite ) fever/chill ( - / - ) Headache/dizziness ( - / - ) Rhinorrhea/ cough /sputum ( - / + / - ) : 3YA, 일상생활 지장 X Dyspnea (+) : ATS grade II chest pain / palpitation ( - / - ) anorexia/nausea/vomiting ( - / - / - ) abdominal pain/discomfort ( + / - ) : 폭식 후 심해짐 constipation/diarrhea ( + / - ) hematemesis/melena/hematochezia ( - / - / + ) : 수술 하였으나 지속 Urinary Sx (-) Arthralgia (+) : both knee Myalgia (-)

6. Physical Exam V/S 172/88 mmHg - 63 - 18 - 36 ℃ G/AGenerally well-looking appearance MentalityAlert & well orientation HEENTpinkish conjunctivae, anicteric sclerae Dehydrated tongue (-) PNS tenderness(-) PTH/PI (-/-) JVP (-) Neck VE (-) Cervical LNE (-/-) Thyroid enlagement (-) ChestSymmetric chest expansion Regular heart beat w/o murmur Clean breathing sound w/o wheezing

7. Physical Exam Abdomen Soft & flat Bowel sound – normoactive No tenderness / rebound tenderness No shifting dullness Back No CVAT Extremities Skin rash(-)Clubbing (-) Joint ROM limitation (-) Joint swelling & stiffness (-) Joint deformity (-)

8. Imaging

9. Spirometry / EKG

10. Problem List / Assessment Problem List #1. solitary pulmonary nodule at RUL #2. Hypertension #3. Hematochezia Assessment #1 : R/O Lung cancer #3 : Recurrent hemorrhoid

11. Diagnostic w/u RUL mass gun Bx Bronchoscopy PET

12. Lung cancer – Dx Screening Sputum cytology, CXR, Low dose CT 최근 연구에서 Benefit 이 있는 걸로 알려짐 Tissue Diagnosis Fiberoptic bronchoscopy, Transthoracic FNA(PCNA) Mediastinoscopy, VATS (thoracoscopy) Operative specimen Staging Procedures

13. Lung cancer – Staging Lung Cancer Staging Essentials: The New TNM Staging System and Potential Imaging Pitfalls

14. Lung cancer – Px Non-small lung cancer 의 Stage 에 따른 예후 Stage IA :MSD 60 개월 / 5YSR 50% Stage IB : MSD 43 개월 / 5YSR 43% Stage IIA: MSD 34 개월 / 5YSR 36% Stage IIB:MSD 18 개월 / 5YSR 25% Stage IIIA: MSD 14 개월 / 5YSR 19% Stage IIIB: MSD 10 개월 / 5YSR 7% Stage IV : MSD 6 개월 / 5YSR 2%